Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyMay 2023
In a real-world study, metabolic outcomes were more favourable with GLP-1 agonists than with SGLT-2 inhibitors.
Glucagon-like peptide-1 (GLP-1) agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors are not US FDA-approved for patients with type 1 diabetes, but some clinicians prescribe these drugs off-label for such patients. In this retrospective, single-centre study, researchers examined outcomes for 104 adults with type 1 diabetes who received either of these agents for an average of two years; 65 patients received only GLP-1 agonists, 28 received only SGLT-2 inhibitors, and 11 received both.
Mean age was about 44 years, mean weight was about 90 kg, mean glycosylated haemoglobin (HbA1c) was about 62 mmol/mol (7.8%) and mean total daily insulin dose was about 60 units. Key outcomes were as follows:
- at 12 months, GLP-1 agonists were associated with statistically significant reductions in HbA1c (0.5 percentage points), weight (5kg), daily insulin dose (12 units) and total and LDL cholesterol
- at 12 months, SGLT-2 inhibitors were associated with a 0.5 percentage-point reduction in HbA1c, but no significant reductions in weight, daily insulin dose or total and LDL cholesterol
- neither drug was associated with changes in renal function or proteinuria
- diabetic ketoacidosis occurred more frequently with SGLT-2 inhibitors than with GLP-1 agonists (13% vs 4% during two years of use)
- 27% of patients in both groups stopped treatment because of side effects.
Comment: Among these relatively young adults with type 1 diabetes – very few of whom had histories of adverse cardiovascular events or kidney disease – intermediate-term metabolic outcomes favoured GLP-1 agonists over SGLT-2 inhibitors. However, the role of these drugs in type 1 diabetes remains unclear. The 2023 ‘Standards of Care’ document from the American Diabetes Association does not advocate their use in type 1 diabetes; it simply states that the ‘risks and benefits ... continue to be evaluated.’
Allan S. Brett, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.
Edwards K, et al. Clinical and safety outcomes with GLP-1 receptor agonists and SGLT2 inhibitors in type 1 diabetes: a real-world study. J Clin Endocrinol Metab 2023; 108: 920-930.
This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.